New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/1/2024 3:59:00 PM
Cost:
250
Service:
Frame + Lenses
prescribed by doctor:
Dr. Ali Abed Hussein Hajj
Notes:
Oliver Peoples Frame + Transition + AR W9 1.67
SPH
CYL
AX
ADD
OD
-4.25
-1.25
90
OS
-4.5
-1.75
75
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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